One year ago 250 leaders gathered in Philadelphia to consider what a recovery-based model of care might look like and what this model would mean related to how we currently research and address addiction in America (see: http://www.ireta.org/ireta_main/rec-sym-videos.html). Despite the wealth of evidence supporting the effectiveness of a recovery-oriented system of care (ROSC), some still write that it is just a treatment fad with promise but without a clear clinical model or solid science to back it up. They are mistaken. Here is why I believe in the promise of ROSC, and why it is not just a passing fad.

The emerging focus on ROSC was inevitable once addiction was understood and accepted as an illness, often chronic in nature, best addressed in a clinical manner that recognizes the possibility of chronicity. This chronic understanding has challenged many aspects of our thinking, practice, payment and policy in prevention, treatment, and research. As addiction professionals began to apply this chronic, person-centered thinking to an illness previously defined more by its acute model of care than by what was actually experienced, there were major conceptual shifts in terminology and delivery of care. The concept of "aftercare" was modified to address the chronic nature of the illness and renamed "continuing care." "Distinct units/levels of care" were reconceptualized as "treatment episodes over a continuum of care," and even "relapse" was reoriented to this chronic perspective as "reoccurrence."

As we were reorienting our clinical understanding of addiction within a continuing care model, many in recovery expressed they could now identify with this new model as a model that is more similar to what worked based on their own experience, i.e. acute treatment coupled with continuing care and/or community recovery supports. This clinical shift to ROSC, bringing the treatment aspect of the continuum of care into line with the etiology and trajectory of the illness, brought a greater focus to recovery in treatment. This switch from an acute to continuing or chronic care understanding and the clinical model described therein brought increased identification with and advocacy from individuals and families in recovery regarding how they attained and sustained their own recovery. Finally synergy between the treatment field and those in recovery is building!

With this chronic understanding comes a challenge to take the wealth of science and experience from other chronic illnesses and use that knowledge to help us enhance the system of addiction care so it will better serve those who need it most - today and in the long-term. Now instead of a unique unit of treatment or single episode of care we need to consider a unifying continuum of care for an illness that needs to be distinctly addressed at each point along its development through a related phase in the continuum: prevention- intervention-treatment-wellness/recovery. At each phase of the continuum we must now identify the potentially diverse symptoms and link individuals to a skilled workforce, including drug and alcohol specialists (i.e., drug and alcohol counselors and others), capable of addressing the most severe manifestations of the illness, akin to cancer specialists and experts in HIV/AIDS, diabetes or depression. Systemically, the continuum will include individual and community prevention, broader medical screening and intervention (e.g., within primary care settings or "medical homes", ERs, pre-natal clinics, and other generalist medical settings) and acute treatment in the community (drug and alcohol agencies) and medical settings, with concurrent focus on treating the pathology and supporting recovery with linkage to available community supports to both goals. If we provide care in this way, we will be able to define the illness of addiction by each person along the illness's potential trajectory of presentation and the related phase of care along the continuum. This new approach will allows us to better understand the true breadth of the illness along the entire continuum (whereas previously the illness was defined primarily by the treatment phase alone) and measure the full impact of prevention, intervention, treatment and recovery over that continuum for each individual and in aggregate.

Now we must define recovery at each level of the continuum and by doing so we will broaden our accountability, as do specialist practitioners for other chronic illnesses, to more than a measure of acute pathology and its stabilization or remission. However, this will only happen if we can broaden our definition of recovery to include more than remission or even sobriety and measure recovery via improvement in life-related domains such as community and personal health and individual citizenship (Betty Ford Institute, 2007; WHO-QOL Instruments, 1998). With this new broad definition of recovery, individuals successfully achieving personal recovery goals even while being sustained on medications will be considered in recovery! Best, this new framework facilitates professionals working with individuals in treatment to develop personalized recovery plans that include increased community supports that empower each person to sustain his or her recovery while reducing clinical severity and lessening instances of illness reoccurrence. Clinically, for each phase of the continuum, we can measure compliance, proper dosage of care provided, and short and long term sustained recovery, similar to measures for other chronic illnesses. If we do all these things, we will have the added benefit of a wealth of aggregate data, real and extrapolated, on the impact, success and value of these efforts at each phase that can be shared publicly with all who rightfully need to be assured of the value of all aspects of the addiction field.

ROSC is not a fad. It just needs work, important unifying and healing work.

Michael T. Flaherty, Ph.D. is the Executive Director of the Institute for Research, Education and Training in the Addictions (IRETA) in Pittsburgh, Pennsylvania. His agency led in the development of the May, 2008 Philadelphia Recovery Symposium and has since assisted in advancing the focus on recovery within a chronic illness model in all levels of science, policy, prevention, intervention and treatment. He can be reached at flahertym@ireta.org.